U.S. patent application number 12/452142 was filed with the patent office on 2010-06-03 for multi-application robotized platform for neurosurgery and resetting method.
This patent application is currently assigned to MEDTECH S.A.. Invention is credited to Lucien Blondel, Bertin Nahum.
Application Number | 20100137880 12/452142 |
Document ID | / |
Family ID | 38988236 |
Filed Date | 2010-06-03 |
United States Patent
Application |
20100137880 |
Kind Code |
A1 |
Nahum; Bertin ; et
al. |
June 3, 2010 |
MULTI-APPLICATION ROBOTIZED PLATFORM FOR NEUROSURGERY AND RESETTING
METHOD
Abstract
The invention relates to a multi-application robotized platform
for neurosurgery, comprising: a planning console comprising
processing means that can especially receive and process digital
images; a positioning robot arm comprising a plurality of arm
segments, one of which is terminal and proximal and the other is
terminal and distal, said segments being interconnected by
articulated elements, the terminal distal arm segment comprising a
receiving element arranged in such a way as to receive tools, and
the robot arm being guided by the planning console; at least one
video image recording means able to record images of the anatomical
region to be processed, said means being electrically connectable
to the processing means of the planning console, and able to be
positioned and fixed to the receiving element of the distal arm
segment in a removable manner; tools, instruments and others
suitable for being positioned and fixed to the receiving element of
the terminal distal arm segment in a removable manner; means for
observing pre-operating and per-operating images, said means being
electrically connected to the planning console for receiving video
signals therefrom relating to the images to be displayed, and/or to
the image recording means. The invention also relates to a method
ensuring an improved resetting of the anatomical region to be
processed in relation to its digital model using said platform.
Inventors: |
Nahum; Bertin; (Baillargues,
FR) ; Blondel; Lucien; (Montpellier, FR) |
Correspondence
Address: |
THE NATH LAW GROUP
112 South West Street
Alexandria
VA
22314
US
|
Assignee: |
MEDTECH S.A.
Montpellier
FR
|
Family ID: |
38988236 |
Appl. No.: |
12/452142 |
Filed: |
June 19, 2008 |
PCT Filed: |
June 19, 2008 |
PCT NO: |
PCT/FR2008/000860 |
371 Date: |
December 17, 2009 |
Current U.S.
Class: |
606/130 |
Current CPC
Class: |
A61B 2090/365 20160201;
A61B 2090/364 20160201; A61B 2090/064 20160201; A61B 34/30
20160201; A61B 34/70 20160201; A61B 90/11 20160201; A61B 34/10
20160201 |
Class at
Publication: |
606/130 |
International
Class: |
A61B 19/00 20060101
A61B019/00 |
Foreign Application Data
Date |
Code |
Application Number |
Jun 19, 2007 |
FR |
0704350 |
Claims
1.-20. (canceled)
21. Multi-application robotized platform for neurosurgery, wherein
the platform comprises: a planning console comprising processing
means capable, in particular, of receiving and processing digital
images, a positioning robot arm comprising a plurality of arm
segments, one of which is terminal and proximal and the other is
terminal and distal, said segments being interconnected by
articulated elements and the terminal distal arm segment comprising
a receiving element arranged in such a way as to receive tools,
said robot arm being guided by the planning console, at least one
means for recording video images capable of recording images of the
anatomical region to be processed, said means being electrically
connectable to the processing means the planning console includes,
and said recording means being capable of being positioned and
removably fixed to the receiving element of the distal arm segment,
said means for recording video images comprising a central optical
axis (AA') and integrating a central laser module aligned with the
central optical axis (AA'), said central laser module being a
rangefinder laser capable of measuring the distance between its
external face and the nearest object pointed by the laser beam,
tools, instruments, and the like, designed to be positioned and
removably fixed to the receiving element of the terminal distal arm
segment, means for displaying pre-operating and per-operating
images, said means being electrically connected to the planning
console for receiving video signals therefrom relating to the
images to be displayed, and/or to the image recording means.
22. Platform according to claim 21, wherein a central unit and a
data input computer interface are associated to the positioning
robot.
23. Platform according to claim 21, wherein the positioning robot
arm has at least six degrees of freedom i.e. three translations and
three rotations.
24. Platform according to claim 21, wherein the robot arm comprises
a force sensor and is designed to operate according to a mode in
which a user can move the robot arm manually by seizing it by its
terminal portion.
25. Platform according to claim 21, wherein the platform is
equipped with a control screen and with a communication interface
designed to receive operating planning parameters from a user.
26. Platform according to claim 21, wherein the processing means
are designed to define each trajectory thanks to three-dimensional
calculations made based on the operating planning parameters and on
the spatial coordinates of the anatomical marks.
27. Platform according to claim 21, wherein the tools comprise at
least one guide, and/or at least one mechanical pointer, and/or at
least one laser pointer, and/or at least one ultrasonic probe,
and/or at least one rangefinder.
28. Platform according to claim 21, wherein the tools comprise at
least one surgical instrument.
29. Platform according to claim 21, wherein the robotized
positioning arm, through its terminal proximal segment, is fixed to
an orientation turret installed fixedly on the upper portion of a
parallelepipedal box comprising elements for rolling on the floor
and means for immobilization with respect to the latter.
30. Platform according to claim 29, wherein the box is provided
with means for fixing to the operating table preventing any
movement of the box with respect to said table.
31. Platform according to claim 29, wherein the box comprises rigid
means for fixing to a head rest installed on the head (H) of a
patient carried by the operating table (T).
32. Platform according to claim 21, wherein the means for recording
video images of the anatomical region to be processed includes two
stereoscopic cameras in order to acquire two stereoscopic video
images of the anatomical region to be processed and that the
visualization means comprise a stereoscopic images visualization
system.
33. Platform according to claim 32, wherein the image recording
means comprises an optical module designed to be interfaced to an
optical cable itself connected to a cold light source.
34. Platform according to claim 32, wherein the image recording
means comprises two laser modules projecting visible laser beams
convergent on a point capable of being adjusted so as to be the
point of intersection of the two optical axes of the stereoscopic
cameras.
35. Platform according to claim 32, wherein the image recording
means comprises a central laser module by rotation according to its
optical axis AA'.
36. Platform according to claim 21, wherein on the or at least one
of the visualization means are displayed video images of the
anatomical region to be processed augmented with virtual elements
in order to ensure an augmented reality functioning.
37. Method for resetting the anatomical region to be processed with
respect to its digital model and a robotized arm using a platform
according to any of the preceding claims, wherein the method
consists in: acquiring, prior to the neurosurgical intervention,
first digital images of the region to be processed and transferring
these digital images to the planning console by means of a network
or of a physical medium so that they are recorded and processed
therein, acquiring in per-operating stage, with the help of a
scanning instrument carried by the element receiving the terminal
distal segment of the robotized arm, second digital images of a
pertinent portion of a body area of the patient appearing already
on the first digital images, and transferring these second digital
images to the planning console so that they are recorded and
processed therein, building a first three-dimensional digital model
based on the first digital images, said model showing the patient's
pertinent body area, building a second three-dimensional digital
model based on the second digital images, still showing the
patient's pertinent body area, and putting in correspondence the
first and second models by superimposition of the representations
of the pertinent body area appearing on one model and on the
other.
38. Resetting method according to claim 37, wherein data delivered
by the rangefinder laser and by the two cameras of the image
recording means are used for building the second digital model.
Description
TECHNICAL FIELD
[0001] This invention is related to the field of materials used in
medicine and more specifically in neurosurgery. It relates in
particular to a multi-application robotized platform for
neurosurgery and the associated implementation method.
STATE OF THE PRIOR ART
[0002] It is known that the practicing of neurosurgery requires the
use of an ever increasing number of dedicated surgical materials
and equipment.
[0003] Thus, stereotaxic frames are used in particular for tumoral
biopsies or the accurate positioning of stimulation electrodes. A
disadvantage of these frames is that they do not lend themselves
well, or at all, to open surgery. Besides their size, another
disadvantage resides essentially in that they require a firm
anchorage in the bones of the cranium.
[0004] Also known are robots that can be used instead of
stereotaxic frames. Also known, from the state of the art, are
neuro-navigation systems offering a solution applicable to open
surgery. These systems permit the detection of anatomical
structures based on a pre-operating imaging given by a scanner, by
a magnetic resonance imaging (MRI) apparatus or the like, and on a
three-dimensional localization system, comprising for example
several light sources attached to the instrument, emitting in the
infrared range.
[0005] These systems comprise in addition one or more cameras
capable of perceiving the infrared and of emitting a signal that
will be processed by an appropriate computer capable of calculating
the data regarding the positions and orientations in space of the
surgical instrument such as the position of the tip of the
latter.
[0006] Typically, before the carrying out of the imaging, the skull
of the patient is equipped with radio-opaque markers, in the form
of pastilles, designed to be affixed next to the skin. The obtained
digital images are transferred to a memory bank of the computer.
With the help of the surgical instrument or of a specific
instrument the surgeon brings the tip of this instrument in contact
with each of the radio-opaque markers. Thus, the position of the
instrument can be located with respect to the previously obtained
digitized medical images. In this way, during the surgical action
in particular, the image of the instrument and its position can be
superimposed to the digital images in view of displaying them
jointly on a display screen.
[0007] The neuro-navigation systems are in particular used for the
detection and resection of cerebral tumors.
[0008] Also known are surgical microscopes used as visualization
tools during open neurosurgical actions (ex.: corticectomy).
[0009] The surgical applications described above and the equipment
associated thereto represent a considerable portion of the routine
practice in neurosurgery.
[0010] However, the plurality of the pieces of equipment and their
specificity pertaining to a type of neurosurgical application are
disadvantageous in the hospital logistical management, and
conflicting with the objectives of flexibility and versatility of
the operating theater.
[0011] Another disadvantage specific to neuro-navigation resides in
the possibilities of errors of resetting between the established
digital model, the patient, and the tool. This is related
essentially to the fact that radio-opaque pastilles are affixed on
the skin, which remains a moving element, and not implanted fixedly
in the cranial bones.
[0012] For the positioning of these radio-opaque markers, the
practitioner tries however to avoid any invasive procedure despite
the risk of loss of resetting precision due to the involuntary
displacement of one of the markers.
[0013] Also known from the state of the art is a robotized guiding
device for surgical tools. Such a tool is in particular described
in patent application FR 2 871 363. This robotized device includes
a robot arm, means for collecting anatomical marks with the help of
the robot arm, means for processing these anatomical marks and
means for automatic positioning of an instrument for guiding a
surgical tool, this guiding instrument being carried by the robot
arm.
[0014] This guiding device is not provided with means for recording
images of the field of operation or with specific means for
visualization of the field of operation.
[0015] This device does not meet the objective pursued by this
invention.
EXPOSITION OF THE INVENTION
[0016] This invention aims at solving the problems mentioned above
by providing, on the one hand, a multi-application solution
substituting all devices listed above and, on the other hand, a
method aiming at an improved resetting of the digital model of the
anatomical region to be processed with the patient and the surgical
tool.
[0017] To this end, the multi-application robotized platform for
neurosurgery is essentially characterized in that it comprises:
[0018] a planning console comprising processing means capable, in
particular, of receiving and processing digital images,
[0019] a positioning robot arm comprising a plurality of arm
segments, one of which is terminal and proximal and the other is
terminal and distal, said segments being interconnected by
articulated elements and the terminal distal arm segment comprising
a receiving element arranged in such a way as to receive tools,
instruments, and the like, said robot arm being guided by the
planning console,
[0020] at least one video image recording means capable of
recording images of the anatomical region to be processed, said
recording means being electrically connectable to the processing
means of the planning console, and said recording means being
capable of being positioned and removably fixed to the receiving
element of the terminal distal arm segment,
[0021] tools, instruments, and the like designed to be positioned
and removably fixed to the receiving element of the terminal distal
arm segment,
[0022] means for displaying pre-operating and per-operating images,
said means being electrically connected to the planning console for
receiving video signals therefrom relating to the images to be
displayed, and/or to the image recording means.
[0023] According to another feature of the invention, the
positioning robot arm has at least six degrees of freedom i.e.
three translations and three rotations thanks to which the tool or
the instrument and the like that it carries can be positioned and
oriented in space in all possible ways.
[0024] According to another feature of the invention, the robot arm
comprises a force sensor and is designed to operate according to a
mode in which a user can move the robot arm manually by seizing it
by its terminal portion. The robot arm then operates in a
cooperative mode.
[0025] According to another feature of the invention, the planning
console is equipped with a control screen and with a communication
interface designed to receive operating planning parameters from a
user.
[0026] Thanks to these arrangements, the processing means can take
into consideration the operating planning parameters in order to
control the trajectory of the positioning robot and in particular
the trajectory of the tool or of the instrument, or of the image
recording means that it carries.
[0027] Thus, the cranial entry point and the target point in the
cervical mass, for example, can be furnished to the platform thanks
to a simple and friendly graphical interface.
[0028] The communication interface can, for example, be in the form
of a keyboard, of a tactile interface and/or of a pointing device,
such as a mouse for example.
[0029] According to particular features of the invention, the
processing means are designed to define each trajectory thanks to
three-dimensional analyses made based on the operating planning
parameters and on the spatial coordinates of the resetting
elements.
[0030] According to another feature of the invention, the tools
comprise at least one contact or contactless probe and/or at least
one ultrasonic probe, and/or at least one rangefinder.
[0031] According to another feature of the invention, the probe is
a mechanical pointing instrument designed to be removably fixed on
the robot arm. In cooperative mode, the user can point an element
on the patient's head by moving manually the pointing instrument
and getting into contact with the target. Such a probe permits the
user to acquire for example the positions of relevant anatomical
points or the positions of radio-opaque markers or the positions of
a multitude of points in contact with the patient's skin in order
to obtain a surface therefrom by reconstruction.
[0032] According to another feature, the probe is a distance
measuring optical module, for example a laser rangefinder.
[0033] Based on the data from coders of the robot arm, on the
geometry of the probe and on the distance measurement provided by
the optical module, the system can calculate the three-dimensional
position of the point of the object intersected by the laser beam
directly in the system of coordinates of the robot arm.
[0034] In this case, the probe provides a virtual contactless
pointing solution. Analogously to the mechanical pointing
instrument, such a probe permits the user to acquire the positions
of relevant anatomical points, of radio-opaque markers or of a
multitude of points in contact with the patient's skin in order to
obtain a surface therefrom by reconstruction.
[0035] According to another feature of the invention, at least one
of the tools is comprised of a tubular guide or guiding sleeve.
[0036] Thanks to these features, the robotized platform equipped
with a tubular guide or with a sleeve mounted fastened on the
receiving element of the positioning arm, can be used as
stereotaxic frame, the sleeve maintained in a fixed spatial
position by the positioning robot arm offering an axial guiding for
a drill bit, for an electrode, for a needle and other instruments
and means usable in the frame of stereotaxic neurosurgery.
[0037] When the pre-operating images (scanner, MRI or other method)
and the position of the patient are put in correspondence, the
system knows the position of the instrument(s) carried by the robot
arm.
[0038] Said instrument positioned by the robot arm in
correspondence with the planning can be a laser pointer or other
pointer type. The laser pointer then permits to target on the
patient an anatomical structure identified on the pre-operating
imaging. In cooperative mode (as defined above), the user is
capable of pointing a target on the patient's head by seizing, by
its terminal portion, the robotized positioning arm equipped with a
laser pointer, and moving it manually. The pointed direction is
represented on the pre-operating images of the planning
console.
[0039] The platform, object of this invention, then advantageously
substitutes a neuro-navigation system.
[0040] The advantage of such a robot arm is that it can maintain
the pointer in position, which is not the case with current
neuro-navigation systems when the pointer is held manually.
[0041] According to another feature of the invention, at least one
of the tools is comprised of a surgical instrument. In this way,
the surgical action will be performed not by the surgeon but by the
robot arm in correspondence with the planning.
[0042] The image recording means is designed to be removably fixed
at the end of the robot arm. Said image recording means comprises
at least one video camera of the digital type, for example.
[0043] Thanks to said image recording means, the user can visualize
on the patient a region of interest, for example a region
identified on the pre-operating imaging. In cooperative mode, as
defined above, the user is capable of visualizing a region of his
choice on the patient's head by seizing the positioning arm by its
terminal portion and by moving it manually. The visualized region
is represented on the pre-operating images of the planning
console.
[0044] The means for displaying images obtained from the camera can
for example, non-restrictively, be a screen of the type 2D and/or a
helmet of the type 2D or even preferably of the type 3D if
stereovision techniques are used. The platform, object of this
invention, then substitutes advantageously a navigated surgical
microscope. The video stream delivered by the image recording means
can be transmitted simultaneously to the screen of the planning
console. Thus, the surgeon and the rest of his team visualize the
same video image of the anatomical region during operation. They
can be transmitted to another visualization means but also,
simultaneously, to that other visualization means and to the screen
of the planning console.
[0045] Instead of manually moving the image recording means by
seizing the robot arm in cooperative mode, the user can also guide
the movements of the robot arm by means of a control box. The same
control box permits the regulation of the camera(s) of the image
recording means, in particular the zoom level and the focusing
distance. This control box can comprise control buttons and/or at
least one control lever.
[0046] Alternately, the positioning of the image recording means in
cooperative mode, i.e. by seizing by its terminal portion the
positioning arm equipped with said recording means and by moving it
manually, can be made without spatial correspondence at the level
of the planning console. The platform, object of this invention, is
then the equivalent to a simple surgical microscope.
[0047] According to another feature of the invention, the means for
recording images of the field of operation and other relevant
anatomical regions, comprises a pair of stereoscopic cameras for
example of the digital type in order to acquire two stereoscopic
video images of the anatomical region to be processed and be able
to render a 3D view of the region thanks to a stereoscopic images
visualization system being part of the invention. The advantage of
this method is to render the perception of the relief to the
surgeon, thus improving the quality of his surgical action.
[0048] According to another feature of the invention, the image
recording means includes an optical module designed to be
interfaced to an optical cable connected itself to a cold light
source. Thus, the device lights the anatomical region to be
processed acquiring at the same time a video stream therefrom.
[0049] A well-known disadvantage of certain operating microscopes
is that they require a powerful lighting of the anatomical region
so that the image transmitted in the binoculars has a sufficient
luminosity. The use of video cameras of the digital type is a
positive advantage since they do not require a powerful lighting.
An ambient lighting can then suffice for a correct vision of the
anatomical region.
[0050] According to another feature of the invention, the image
recording means includes two laser modules projecting visible laser
beams. Said laser beams converge on one point which can be adjusted
to be the point of intersection of the two optical axes of the
stereoscopic cameras.
[0051] These convergent laser modules bring an advantage during the
use, since they indicate the optimal working area for the
perception of the relief. They are also advantageous in production
for facilitating the centering of the two stereoscopic cameras on
the same point and determining the geometry of the image recording
means tool.
[0052] According to another feature of the invention, the image
recording means includes a central laser module aligned with the
central optical axis of the pair of stereoscopic cameras. Said
visible laser beam materializes the axis in which the video image
of the anatomical region is acquired.
[0053] According to another feature of the invention, the central
laser module is a rangefinder laser capable of measuring the
distance between its external face and the nearest object pointed
by the laser beam.
[0054] According to another feature of the invention, the image
recording means includes a mechanical system for rotation around
its optical axis. The user can thus rotate the image recording
means with the help of a handle in order to orient the video image
of the anatomical region according to the needs of its surgical
action.
[0055] According to another feature, the invention integrates a
mechanical pointer equipped with at least one visible marker,
itself well-known, designed to be located on the video images
acquired by the image recording means. The position of the tip of
the pointer can then be calculated by triangulation by identifying
the marker(s) on the two stereoscopic images. This calculation
requires first a calibration of each of the two cameras (intrinsic
parameters) as well as calibration of the stereoscopic system
(position and orientation of one camera with respect to the other).
The advantage of this solution is that the pair of stereoscopic
cameras is situated in an area near the anatomical region to be
processed and that one thus gets rid of the <<line of
sight>> problem common to existing optical localization
neuronavigation systems.
[0056] When the pre-operating images (scanner, MRI or other method)
and the position of the patient are put in correspondence, the
system knows the position of the image recording means carried by
the robot arm. The system can then advantageously substitute a
microscope combined with a neuro-navigation system. The point of
interest displayed on the anatomical region and on the
pre-operating images of the planning console can be for example the
point of intersection of convergent laser beams and/or the point of
impact of the central laser beam and/or the point in contact with
the mechanical pointer equipped with visible markers.
[0057] According to another feature of the invention, a
stereoscopic images visualization system of the three-dimensional
type is provided.
[0058] According to a feature of the invention, the stereoscopic
images visualization system is comprised of two screens designed to
display two video images derived from different sources. Said
screens can advantageously be mounted on a helmet or on glasses so
that the surgeon keeps his hands free for his surgical action.
[0059] Said visualization system can be used during the
intervention planning stage on the console for displaying a
realistic view of the 3D virtual objects; for example, the digital
model of the patient established based on the pre-operating images,
or on the planning virtual objects such as a target point, an entry
point, a rectilinear trajectory, a surface of interest, a volume of
interest, etc.
[0060] The surgeon thus handles directly data in three-dimensional
form, unlike the existing neuro-navigation systems, which only have
a screen displaying data in two-dimensional form.
[0061] The device can also advantageously substitute an operating
microscope by displaying through the visualization system the video
images derived from the image recording means. The surgeon can then
operate in the position he considers optimal for his surgical
action.
[0062] Once the pre-operating images (scanner, MRI or other method)
and the position of the patient in the operating theater are put in
correspondence, the planning console knows the position of the
image recording means carried by the robot arm. Knowing a priori
the projective model of the cameras, it is possible to superimpose
the virtual images on the real images in order to display a defined
element of the targeted anatomical region. This element can be for
example a tumor in case of a tumor resection, or a target point, or
an entry point, or a trajectory, or an instrument, or even an
anatomical region of interest. The stereoscopic visualization
system then displays video images of the anatomical region,
augmented with planning virtual elements. Then the function of
augmented reality is ensured.
[0063] Augmented reality permits to provide precious data to the
surgeon while he is operating. This is a very advantageous function
because it permits the surgeon to avoid the situation in which he
had to look alternately the region he was operating and the
pre-operating images displayed on a screen and make the
correspondence between said data mentally. All data are projected
in a superimposed manner on the same screen. The stereoscopic
visualization system can display in particular data in textual
form, for example distances or volumes.
[0064] These features give the platform a multi-application nature
corresponding to the needs of hospital centers in terms of
logistical management and maintenance and meet the objectives of
flexibility and versatility of the operating theater.
[0065] Another object of this invention is a method aiming at
augmenting the precision of the resetting between the anatomical
region to be processed, its digital model and a robotized arm.
[0066] To this end, the method according to the invention consists
in:
[0067] acquiring, prior to the neurosurgical intervention, first
digital images of the region to be processed and transferring said
digital images to the planning console by means of a network or of
a physical medium so that they are recorded and processed
therein,
[0068] acquiring in the per-operating stage, with the help of a
scanning instrument carried by the element receiving the terminal
distal segment of the robotized arm, second digital images of a
pertinent portion of a body area of the patient appearing already
on the first digital images, and transferring said second digital
images to the planning console so that they are recorded and
processed therein,
[0069] building a first three-dimensional digital model based on
the first digital images, said model showing the patient's
pertinent body area,
[0070] building a second three-dimensional digital model based on
the second digital images, still showing the patient's pertinent
body area,
[0071] and putting in correspondence the first and second models by
superimposition of the representations of the pertinent body area
appearing on one model and on the other.
[0072] Thus, such a method does not require the presence of
radio-opaque markers and increases the degree of precision of the
resetting between the pre-operating model, the patient and the
robotized arm.
BRIEF DESCRIPTION OF THE FIGURES OF THE DRAWINGS
[0073] Other advantages and features of the invention will appear
while reading the description of a preferred embodiment given as a
non-restrictive example referring to the attached drawings, in
which:
[0074] FIG. 1 is a synoptic view of the platform according to the
invention,
[0075] FIG. 2 is a perspective view of a platform according to the
invention,
[0076] FIG. 3 is a detailed view of the platform according to the
invention,
[0077] FIG. 4 is a schematic view showing an exemplary embodiment
of means for immobilizing the box with respect to the floor, said
means being in an unfolded position,
[0078] FIG. 5 is a schematic view of an exemplary embodiment of
means for fixing the box to a head rest designed for receiving the
head of the patient to be operated,
[0079] FIG. 6 is a schematic view of an exemplary embodiment of a
contactless probe carried by the robot arm,
[0080] FIG. 7 is a schematic view of an exemplary embodiment of an
image recording means,
[0081] FIG. 8 is a schematic view of an exemplary embodiment of
visualization means of the three-dimensional type,
[0082] FIG. 9 is a schematic view of an exemplary embodiment of a
mechanical pointer equipped with a visible marker.
IMPROVED MANNER FOR IMPLEMENTING THE INVENTION
[0083] As shown, the multi-application robotized platform for
neurosurgery, according to the invention, includes a planning
console 1, which can be loaded, comprising processing means 2
capable, in particular, of receiving and processing digital images,
a robotized positioning arm 3 comprising a plurality of arm
segments, one of which is terminal and proximal and the other is
terminal and distal, said segments being interconnected by
articulated elements and the terminal distal arm segment comprising
a receiving element 5 arranged in such a way as to receive, in a
fixed state, removably, tools 4, instruments, and the like, said
robot arm being guided by the planning console 1.
[0084] The platform also comprises a set of tools and possibly
surgical instruments designed to be positioned and removably fixed
to the receiving element 5 of the terminal distal arm segment as
explained previously, as well as a means 14 for recording video
images of the field of operation and means for displaying 6
pre-operating and per-operating images. Said visualization means
are electrically connected to the planning console for receiving
video signals therefrom related to the images to be displayed,
and/or to a means 14 for recording video images such as a
camera.
[0085] The visualization means can include visualization means of
the three-dimensional type.
[0086] The platform will also be equipped with a control screen 60
and with a communication interface 61 designed to receive operating
planning parameters from a user.
[0087] A central unit and a data input computer interface, which
can be part of the abovementioned communication interface, are
associated to the positioning robot arm 3.
[0088] The robotized positioning arm 3, by its terminal proximal
segment, is fixed to an orientation turret installed fixedly on the
upper portion of a parallelepipedal box 7. This box contains
electronics suitable in particular for controlling the arm 3.
[0089] Between the arm segments of the positioning robot arm 3 are
provided articulated elements, for example six, comprising motors
and incremental coders associated, at the level of each articulated
element, to the axle or to each of the swivel pins defined by the
latter. Each motor is capable of driving into rotation two
contiguous segments one with respect to the other and each
associated incremental coder is capable of providing information
relative to the angular position of one of these segments with
respect to the other. The articulated elements permit to position
the terminal tool, the instrument and the like, both in position
(three degrees of freedom) and in orientation (three degrees of
freedom). The angular values measured by the incremental coders
permit, thanks to the known geometry of the robotized arm and to
the known geometry of the tool, instrument and the like carried by
the arm 3, to calculate the Cartesian position of the distal end of
the robotized arm, the Cartesian position of the end of the tool,
instrument and the like and the orientation of the latter in
space.
[0090] The arm, as described, receives an appropriate fairing so as
to have a minimum of nooks in order to avoid the risk of dust or
pathogenic elements penetrating and thriving therein.
[0091] The box 7 comprises in its lower portion omnidirectional
rolling elements 8 such as casters carried each by an
omnidirectional mounting having a vertical rotation axis. Said
casters 8 and mountings ensure an easy movement on the ground.
[0092] The box 7 comprises means for immobilization with respect to
the floor so as to prevent its movement during the surgical
intervention.
[0093] According to a first embodiment, these immobilization means
are comprised of blocking elements, well-known per se, associated
to the casters 8 and to the mountings, when they are activated,
prevent the rotation of the casters around their natural axis of
rotation and the pivoting of the mounting around the vertical axis.
The box is thus immobilized with respect to the floor.
[0094] According to a variant embodiment, as shown in FIG. 4, the
means for immobilizing the box 7 with respect to the floor are
comprised of at least three feet 70 that can occupy either a
retracted position according to which they are placed away from the
floor, or an unfolded position according to which they are placed
in contact with the floor in order to immobilize the box, each foot
70 being moved from one position to the other by a driving
mechanism 71.
[0095] According to a particular embodiment, each foot is formed by
the terminal portion of the rod of a hydraulic single-action jack
associated to an appropriate hydraulic circuit 72 common to
different jacks, comprising in particular, as well known, at least
one hydraulic distributor and a hydraulic pump driven by an
electric motor guided by a remote control. The distributor or each
distributor will be electrically controlled, for example. The motor
71 can also be formed of an electric jack.
[0096] Thus, the user can let the feet 70 down in order to
stabilize the box 7, without exerting any particular effort.
[0097] The box 7 can be provided with means for fixing to a
surgical table on which the patient to be operated has been placed
beforehand, the head H of the latter being maintained firmly in an
appropriate position by a head rest that is fixed with respect to
the table.
[0098] The means for fixing the box 7 to the operating table
prevent any movement of the box with respect to said table and are
comprised of two mounting flanges 9 capable of cooperating, each,
in a fixed state with one of the rails of the table, each flange
being brought adjustably in position by a support structure 10
integral with a support rail 11 carried by one of the sides of the
box 7. The shape and dimensions of each mounting flange 9 are
compatible with those of the rails of the table. Each support
structure 10 is formed of a vertical arm 10a receiving the
corresponding mounting flange 9. This flange 9 is mounted with a
possibility for movement in height along the vertical arm 10a and
comprises a tightening element such as a compression screw or the
like, for immobilization on the arm 10a according to the
appropriate position. Each support structure also has a horizontal
arm 10b fixed to the vertical arm 10a. This horizontal arm 10b
comprises a second vertical arm 10c introduced in a slide mounted
adjustably in position in the support rail 11 of the box 7. This
second vertical arm will be immobilized in the slide by means of a
screw, which also ensures the immobilization of the slide in the
support rail 11.
[0099] According to another embodiment, as shown in FIG. 5, the box
7 is no longer fixed to the operating table T, but directly to a
head rest 15 designed for receiving the head H of the patient to be
operated, the latter being placed on the operating table T. This
box 7 is connected to the head rest 15 through specific fixing
means ensuring, when it is activated, a rigid link between the box
7 and the head rest 15. This arrangement has the advantage of being
rid of the flexibility of the operating table T. These fixing means
can be placed in a so-called inactive state permitting the
appropriate positioning of the box 7 with respect to the head rest
15.
[0100] As a non-restrictive example, this means can be formed of an
articulated mechanical arm 16, comprised of several arm segments
16a connected two by two by articulated elements 16b associated to
immobilization flanges, not shown, that can each occupy either a
locked position of the associated articulated element or an
unlocked position of the latter.
[0101] As mentioned above, a central unit 30 and a data input
computer interface 32 are associated to the positioning robot arm
3.
[0102] The central data unit 30 can be placed in the box and be
part of the electronics the latter transports.
[0103] The robotized platform can also include a contact or
contactless probe.
[0104] The contact probe can be formed of a mechanical pointer
carried by the terminal distal segment of the robot arm. Said
mechanical pointer designed to be brought into contact with the
target to be acquired can include a pointing ball or a dry
point.
[0105] A contactless probe 17 formed of a distance measuring
optical module such as, for example, a laser rangefinder, is
schematically shown in FIG. 6 in association with a robot arm 3.
One can see in this Figure that said probe 15 is carried by the
terminal distal segment of the robot arm and is oriented toward a
characteristic point of the head H of the patient.
[0106] The image recording means 14 comprises at least one video
camera of the digital type, for example. In a preferred embodiment,
as shown in FIG. 7, the means for recording images of the field of
operation comprises, on a support plate 140, two stereoscopic
cameras 141, for example of the digital type, in order to acquire
two stereoscopic video images of the anatomical region to be
processed and so as to be able to render a 3D view of said region
thanks to a stereoscopic image visualization system as described
below. It should be noted that said two cameras 141 are arranged
symmetrically with respect to the central optical axis AA'.
[0107] Said image recording means is in addition provided with an
optical module 142 designed to be interfaced to an optical cable
143 itself connected to a cold light source 142a in order to light
the anatomical region to be processed.
[0108] According to an advantageous arrangement of the invention,
the image recording means 14 comprises two laser modules 143
lateral with respect to the cameras 141 and preferably arranged
symmetrically with respect to the optical axis AA'. Said laser
modules 143 project visible laser beams and are oriented so that
their beams converge on a point that can be adjusted to be the
point of intersection of the two optical axes of the stereoscopic
cameras. As shown, the point of convergence belongs to the optical
axis AA'.
[0109] These convergent laser modules 143 offer an advantage during
the use, since they indicate the optimal working area for the
perception of the relief. They are also advantageous in production
for facilitating the centering of the two stereoscopic cameras on
the same point and determining the geometry of the image recording
means tool.
[0110] The image recording means 14 comprises, in addition, a
central laser module 144 aligned with the central optical axis AA'.
This visible laser beam materializes the axis in which the video
image of the anatomical region is acquired.
[0111] The laser module 144 is a rangefinder laser capable of
measuring the distance between its external face and the nearest
object pointed by the laser beam.
[0112] The image recording means 14 can include a mechanical system
for rotation about its optical axis AA' permitting the orientation
of the video image formed on the visualization means.
[0113] Such a rotation system can be made by means of a pivot link
or pivot sliding with the whole of the elements described above,
integral with a shaft 145 introduced with adjustment sliding in the
through bore of a sheath 147 provided with a support 148 for
removable fastening to the receiving element 5 of the terminal
distal segment of the robotized arm. This shaft 145 can be fixed
rigidly to the plate 140.
[0114] Externally to the sheath 146, the shaft 145 will receive a
handle for pivotal operating 147 through an action on which the
image recording means 14 can be oriented appropriately. A
tightening mechanism with jaws for example, not shown, can be
attached to the sheath 146, designed to exert a tightening effort
on the shaft 145 when it is activated in order to prevent any
pivoting movement of the recording means 14 with respect to the
sheath 146. This jaw mechanism can be made inactive by acting on a
control installed on the handle 147. When inactive, said tightening
mechanism permits the pivoting of the recording means 14 with
respect to the sheath 146.
[0115] FIG. 8 represents an exemplary embodiment of visualization
means 18 of the three-dimensional type. This stereoscopic
visualization means, designed to be carried by the surgeon,
includes a helmet 180 designed to be inserted onto the head of the
surgeon and two visualization screens 181 that can be positioned in
front of the eyes of the surgeon. The visualization screens can
display video images of the anatomical region to be processed,
possibly enriched with virtual elements of the planning in order to
ensure an augmented reality functioning.
[0116] FIG. 9 represents a mechanical pointer 19 equipped with at
least one visible marker 20, designed to be located on the video
images acquired by the image recording means. It can be seen in
this Figure that the marker 20 comprises strongly contrasting areas
in this particular case white areas and black areas. Thanks to the
marker 20 the spatial position of the tip of the pointer 19 can be
calculated by triangulation by identifying the marker on the two
stereoscopic images provided by the two video cameras of the image
recording means 14.
[0117] The robotized platform object of this invention permits the
positioning of a guide, of a probe or of a video image recording
means. Its utilization is based on four stages:
[0118] a first stage of acquiring digital images (scanner or MRI)
of the region to be processed and transferring these digital images
to the planning console 1 by means of a network or of a physical
medium,
[0119] a second stage of processing said images, identifying the
anatomical structures and planning the surgical action, for example
the definition of an entry point and of a target point for
establishing a trajectory of a biopsy needle,
[0120] a third stage of putting in correspondence the pre-operating
images with the position of the patient's head in per-operating
phase according to one of the embodiments described below,
[0121] and finally a last stage of automatic positioning of a
terminal tool 4, for example a guide, a laser pointer, a camera, a
capturing device and the like.
[0122] The robotized platform according to the invention takes up
the same hypotheses regarding the sagging of the brain and the
possible flexion of the needles, as well as the stereotaxic frames,
the neuro-navigation systems and the robotic systems.
[0123] The pre-operating images can be put in correspondence with
the position of the patient in the operating theater in several
ways thanks to the different technologies integrated in the
platform.
[0124] According to a first embodiment, the resetting method
resorts to radio-opaque markers.
[0125] During the intervention, the pre-operating images (scanner
or MRI or other method) can be put in correspondence with the
position of patient's head thanks to markers designed to be located
on the imaging, for example radio-opaque markers. In this case,
said markers are placed on patient's head prior to the acquisition
of the pre-operating images. They are identified on the images
during planning stage in order to determine their position in the
image mark (automatically with a possibility of a manual
retouching).
[0126] During the intervention, the surgeon places the robotized
positioning arm in cooperative mode and manually moves said
positioning robot arm equipped with a probe in order to locate the
positions of the different markers in the robot mark. Once the
positions of markers in the image mark and in the robot mark are
known, a point-by-point resetting algorithm permits to put the two
marks in correspondence.
[0127] This method can be implemented with different types of
probe: the mechanical pointing instrument and the virtual
contactless probe (laser rangefinder).
[0128] Alternately, the surgeon places the robot arm equipped with
the image recording means 14 above the head of the patient. The
surgeon can then manually proceed to the detection of the
radio-opaque markers by using the mechanical pointer 19 equipped
with black and white visible markers 20. The system can also
proceed automatically to the detection of the radio-opaque markers
by positioning the image recording means 14 in different positions
around the head H of the patient, acquiring stereoscopic images
containing radio-opaque markers, segmenting the images for locating
the radio-opaque markers and calculating by triangulation of their
three-dimensional positions in the system of coordinates of the
robot arm. In order to facilitate the detection of the radio-opaque
markers, specific markers having a strong contrast in the visible
spectrum can be used.
[0129] Once the positions of the markers in the image mark and in
the robot mark are known, a point-by-point resetting algorithm
permits to put the two marks in correspondence.
[0130] According to another embodiment, the method does not resort
to radio-opaque markers.
[0131] Alternatively, the putting in correspondence of the image
and robot marks is made based on anatomical surface marks instead
of markers. During the intervention, the surgeon manually moves the
positioning robot arm equipped with a probe in order to locate the
positions of characteristic anatomical points or surfaces such as
the nose, arches, ears, teeth or other. A dots-surface or
surface-surface resetting algorithm permits to reset the dots or
surfaces thus acquired with the pre-operating examinations.
[0132] This method can be implemented with different types of
probe: the mechanical pointing instrument, the virtual contactless
probe (laser rangefinder), the mechanical pointer equipped with
black and white visible markers.
[0133] This method for putting in correspondence has the advantage
of not requiring any installation of markers on patient's head
prior to the imaging.
[0134] According to the method explained above, the robot arm is
manually moved by the surgeon.
[0135] Alternatively, the acquisition of characteristic anatomical
surfaces is made contactless and automatically, by scanning the
whole or portion of the head H of the patient. Such an acquisition
can be obtained by a contactless measuring sensor 4 for example a
laser rangefinder, fixed at the end of the positioning robot arm 3.
Said robot arm automatically scans the region of interest by
driving said sensor 4 according to an appropriate movement in front
of said region of interest, for example, at constant speed
according to a rectilinear translation movement. Knowing the exact
position of the sensor 4 in the robot mark permits the
reconstruction of anatomical surfaces.
[0136] This method can also be implemented with the image recording
means when it comprises a laser rangefinder. This is particularly
advantageous during a navigated microscopy procedure, because it is
no longer necessary to change the tool during the intervention.
[0137] An echographic probe can also be used instead of the
contactless measuring sensor. In this case, the putting in
correspondence of the image and robot marks can be made thanks to a
processing algorithm based on the properties of the image such as
intensity, gradient, and other properties.
[0138] These automatic methods for putting in correspondence do not
require any manual intervention by the surgeon.
[0139] Once the putting in correspondence is done, the robot
automatically positions the tool attached to the receiving element
on the planned trajectory.
[0140] It stands to reason that this invention can receive all
variants within the field of technical equivalents without however
departing from the scope of this patent as defined by the claims
below.
* * * * *